Medicaid Health Plan Pharmacy Benefit

 

This webpage is designed to provide easy access for members and providers looking for information on the drugs and supplies covered by Michigan Medicaid Health Plans.

All plans must at a minimum cover the drugs listed on the Medicaid Health Plan Common Formulary.

History of Formulary Changes

General Formulary Information

FOR PROVIDERS AND PRESCRIBERS ONLY
Prior Authorization (PA) Step Therapy

The Prior Authorization criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring PA is below:

Drug PA Criteria

A standard prior authorization form, FIS 2288, was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription drugs. This form or a prior authorization used by a health plan may be used.

The Step Therapy criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring ST is below:

Step Therapy Criteria

 

Medicaid Common Formulary Workgroup Members

Scroll down for health plan specific information.

 

MEDICAID HEALTH PLANS

Plans may choose to include additional drugs that are not on the Medicaid Health Plan Common Formulary in their own drug formularies. In addition, plans may enforce drug utilization management policies such as quantity limits, age and gender edits, prior authorization criteria and step therapies that are less restrictive than the coverage parameters of the Medicaid Health Plan Common Formulary. Click on the health plans below for more information about their formularies and pharmacy related contact information.

 

Aetna logo

 

Blue Cross Complete of Michigan Logo

 

HAP Midwest Health Plan Logo

 

 

Harbor Health Plan

 

McLaren Health Plan

 

Meridian Health Plan

 

 

Molina Healthcare

 

Priority Health

 

Total Health Care

 

UnitedHealthcare Community Plan

 

Upper Peninsula Health Plan

 

 

 

RESOURCE INFORMATION

     BENEFICIARIES
Current beneficiaries can find out which health plan they are enrolled in by calling the Beneficiairy Help Line at 800-642-3195 (TTY 866-501-5656) or by logging in to their myHealth Portal account online at www.michigan.gov/myhealthportal.

   

     PROVIDERS
For more information on the drug benefit for people not enrolled in a health plan (Fee-for-Service Medicaid) visit https://michigan.fhsc.com.

For more general information on Michigan Medicaid Health Plans, visit www.michigan.gov/managedcare.

   

    STAKEHOLDER MEETINGS AND COMMENT PERIOD

October 9, 2017 Stakeholder Meeting Presentation

Stakeholder Meeting Questions and Answers

Frequently Asked Questions for Drug Manufacturers   

 

The next Michigan Medicaid Health Plan Common Formulary public comment period will be announced here.